﻿<div class="home"  style="margin-top: -20px;">
	<div class="col-xs-12 col-sm-12" style="padding-top:60px">
		<div class="col-xs-2 col-sm-2"></div>
		<div class="col-xs-9 col-sm-9" id="min-min">			
			<center>
				<h5 class="color-text1" style="font-size:29px; text-transform:uppercase;font-weight:bold">
					"NO MORE THREAT" <br></h5>
			</center>
			<center>
				<h5 class="color-text1" style=" margin-top:-10px">
					<span style="font-size:28px;">với Clarithromycin! </span></h5>
			</center>
			
			<?php echo $this->Form->create('Clarithromycin',array('class'=>'form-signin form-horizontal'));?>
			  <div class="form-group">
					<center><span style="color:red">
                            <?php if($this->Session->read('erroMSG') && $this->Session->read('erroMSG')!=""){
                                echo $this->Session->read('erroMSG');
                            }?></span></center>			  
				 <label class="col-sm-3 col-xs-3 control-label input-sm"><span style="color:red">*</span>Tên bác sỹ </label>
				 <div class=" col-xs-6 col-sm-6 ">
					<?php 
						echo $this->Form->input('name', array('div'=>'clearfix',
							'before'=>'<label>'.__('').'</label><div class="input">',
							'after'=>$this->Form->error('name', array(), array('wrap' => 'span', 'class' => 'help-inline')).'</div>',
							'error' => array('attributes' => array('style' => 'display:none')),
							'label'=>false, 'class'=>' form-control input-sm',							
							'placeholder'=>'Tên bác sỹ '
							));
					?>
					
				 </div>
				 
			 </div>			 
			 <div class="form-group">				
				 <label class="col-sm-3 col-xs-3 control-label input-sm"><span style="color:red">*</span>Bệnh viện</label>
				 <div class=" col-xs-6 col-sm-6 ">
					<?php 
						echo $this->Form->input('organ', array('div'=>'clearfix',
							'before'=>'<label>'.__('').'</label><div class="input">',
							'after'=>$this->Form->error('organ', array(), array('wrap' => 'span', 'class' => 'help-inline')).'</div>',
							'error' => array('attributes' => array('style' => 'display:none')),
							'label'=>false, 'class'=>' form-control input-sm',							
							'placeholder'=>'Bệnh viện'
							));
					?>
					
				 </div>
			 </div>
			 <div class="form-group">				
				 <label class="col-sm-3 col-xs-3 control-label input-sm"><span style="color:red">*</span>Phòng / Khoa</label>
				 <div class=" col-xs-6 col-sm-6 ">
					<?php 
						echo $this->Form->input('faculty', array('div'=>'clearfix',
							'before'=>'<label>'.__('').'</label><div class="input">',
							'after'=>$this->Form->error('faculty', array(), array('wrap' => 'span', 'class' => 'help-inline')).'</div>',
							'error' => array('attributes' => array('style' => 'display:none')),
							'label'=>false, 'class'=>' form-control input-sm',							
							'placeholder'=>'Phòng / Khoa'
							));
					?>
					
				 </div>
			 </div>
			 <div class="form-group">				
				 <label class="col-sm-3 col-xs-3 control-label input-sm"><span style="color:red">*</span>Email</label>
				 <div class=" col-xs-6 col-sm-6 ">
					<?php 
						echo $this->Form->input('email', array('div'=>'clearfix',
							'before'=>'<label>'.__('').'</label><div class="input">',
							'after'=>$this->Form->error('email', array(), array('wrap' => 'span', 'class' => 'help-inline')).'</div>',
							'error' => array('attributes' => array('style' => 'display:none')),
							'label'=>false, 'class'=>' form-control input-sm',							
							'placeholder'=>'Email'
							));
					?>
					
				 </div>
			 </div>
			 <div class="form-group">				
							 <label class="col-sm-3 col-xs-3 control-label input-sm"><span style="color:red">*</span>Điện thoại</label>
							 <div class=" col-xs-6 col-sm-6 ">
								<?php 
						echo $this->Form->input('mobile', array('div'=>'clearfix',
							'before'=>'<label>'.__('').'</label><div class="input">',
							'after'=>$this->Form->error('mobile', array(), array('wrap' => 'span', 'class' => 'help-inline')).'</div>',
							'error' => array('attributes' => array('style' => 'display:none')),
							'label'=>false, 'class'=>' form-control input-sm',							
							'placeholder'=>'Điện thoại'
							));
					?>
								
				 </div>
			 </div>
			<div class="checkbox">
			<label>
			  <input type="checkbox" checked="checked"> <i style="font-size:11px;">Tôi đồng ý cho phép Ban tổ chức chương trình sử dụng thông tin đã nhập trên đây để nhận được thông báo về kết quả chương trình</i>
			</label>
		  </div><p></p>	
			 <center> <button type="submit" class="btn btn-info btn-sm">&nbsp;ĐĂNG NHẬP&nbsp;</button></center>
			<?php echo $this->Form->end();?>
			<div class="help-block" style="font-size:10px;color:red;float:left;padding-top: 50px;padding-left:100px;"> * Bắt buộc</span></div>
		</div>		
	</div>
</div>

